Health Insurance Is a Key Factor in International Students’ Choice of Canadian College

When the Government of Manitoba de-listed provincial health care as a “right” for foreign students at its universities this September, reaction to the move revealed just how significant health care insurance was to students’ choice of school.

As one student from Nigeria enrolled at the University of Manitoba told local media, “free” health care was an important factor when he was deciding where to attend university. He added, “It was a big issue when I was considering Manitoba.”

The student, who as a foreign national was paying at least two to three times the tuition and fees charged domestic students, was reacting to the provincial government’s repeal of a 2012 clause to the Health Insurance Act that offered foreign students access to its provincial health care scheme—access which covered not only them, but their spouses and dependents.

The repeal was expected to save Manitoba taxpayers $3.1 million while costing foreign students or their families or sponsors anywhere from $400 for a stripped-down, basic single plan to $3,600 per year for insurance for a family with enhanced comprehensive/preventive care coverage from the private sector. To soften the blow, the U of M and University of Winnipeg agreed to pay the fees for the remainder of the school year that began in September 2018, but their largesse will not extend to foreign students beyond that date. At present, 18 per cent of U of M students are international students.

A harbinger for other provinces?

Manitoba’s action will surely be watched by other provinces offering similar access to their provincial health insurance programs in what some analysts of Canadian college recruitment practices characterize as an “addiction to international student fees.”

At present, all provinces except Ontario, Prince Edward Island, and Quebec (with some exceptions) provide international students access to their tax-funded provincial health insurance plans, with variations from province to province. Quebec has treaty obligations with several European countries by which it offers health care reciprocity. But aside from that, schools in these three provinces provide university health insurance plans sponsored by the schools but administered by private insurers.

(Private insurers also provide a full slate of individual and family plans directly to students and dependents, as well as short-term “bridge” plans that cover enrollees during some provincially mandated “waiting periods.”)

Must foreign students subsidize Canada’s higher education?

According to the Canadian Bureau for International Education, there are currently 494,525 international students at all levels of study in Canadians schools—119 per cent more than in 2010, and 51 per cent of whom intend to remain in Canada when they complete their studies.

In a paper published by Policy Options, Alex Usher, president of Higher Education Strategy Associates (HESA)—a consulting firm that advises governments, institutions and corporations in the higher education sector—wrote that fees for international students, which average about four times what domestic students pay, now equal 12 per cent of operating revenues and 35 per cent of all fees collected by educational institutions.

He adds that some major schools, including the University of Toronto, receive more money from international students than they get in operating grants from provincial governments.

But he also warns of a day of reckoning in that the recent run-up in international student numbers has been facilitated by a decline in the numbers of Canadians turning 18—a demographic that won’t last. He notes that early next decade, the number of 18-year-olds in western Canada will start to rise (in Ontario that won’t happen until the late 2020s). At that point, “institutions are going to be forced to make difficult choices between their lucrative international students and their domestic constituencies.”

The hard choice debate he proposes: “should there be a limit to how much we ask foreigners to subsidize our own education system? If so, are we prepared to pay more as a result? It’s a debate we should have, rather than continuing to ignore the trends.”

Indeed, in some areas of Canada, the “subsidies” affect not only education, but local economies as well.

As Kelly Toughill, associate professor at the University of King’s College, Nova Scotia, writes in The Conversation, “More than 25,000 students currently hold permits to study in Atlantic Canada. They are keeping universities afloat as domestic enrolment plummets; they are a major part of the regional economy and they are a prime source of the immigration needed to counter the region’s rapidly aging population.”

In fact, according to a study commissioned by the Council of Nova Scotia University Presidents, in-province spending by international students is Nova Scotia’s fourth-largest export—smaller than seafood processing but above fishing exports and forest products. (See the full study results here [PDF].)

There are many reasons Canada has become such an attractive destination for higher education, often rated as among the top three destinations including the U.S. and Britain: quality and cost. And it appears health care is a factor in that equation—just ask the international students.

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Milan Korcok has been covering international health care activities and trends in Canada, the U.S., and abroad since the introduction of Canada’s medicare system in the late’60s. He has long served as contributing editor to the Canadian Medical Association Journal, the Journal of the American Medical Association, and currently serves as contributor to the International Travel Insurance Journal, published in the UK and distributed globally.

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